It was my freshman year of college at the University of Washington when I decided that I wanted to pursue global health. I had just finished taking GH 101 with Professor Stephen Gloyd, a leading global health practitioner, and wrapped up my first year working as an undergraduate research assistant at the Institute for Health Metrics and Evaluation. I was passionate about the work.
Throughout my education at the University of Washington and Harvard, I’ve been separated from the reality of global health work. My research has always been data analysis, demographic projections, coding in R and STATA, and developing data visuals. Slowly, I started seeing global health as just a quantitative discipline that required constant churning of numbers to draw any conclusions. My few weeks in Shillong have renewed my commitment to the field and reminded me that this was a field developed to help humanity. We get caught up in the numbers and the academic currency of publications, but our ultimate goal is to help ensure that the right to health is realized for all.
Last week, I had the opportunity to visit Mawkynrew Block in the East Khasi Hills. We drove out of Shillong and through beautiful roads that were surrounded by lush greenery, hills and gorges. Once we got to the village, we attended a block meeting at Jongksha District. The purpose of the visit was to assess the effectiveness of programs aimed at reducing maternal deaths and to understand the perspectives of various stakeholders, including village members, village headmen, ASHAs (Accredited Social Health Activists), and medical officers. During the visit, we had the opportunity to visit the Primary Health Center (PHC) in Jongksha Village. At the meeting, it was revealed that programs promoting institutional deliveries at PHCs had proven to be effective in reducing maternal deaths. The utilization of ambulances for transportation to PHCs played a crucial role in ensuring safe delivery and timely access to medical assistance. Medical officers also discussed avoidable maternal deaths that had previously occurred in the district. This was meant to highlight underlying issues in the health system, ranging from issues with the diagnosis of other conditions to delayed care. Attending this meeting was a valuable experience for me for several reasons. First, I was able to hear the insights of various stakeholders, including mothers who had participated in institutional delivery. Second, I was able to learn what the barriers to care looked like in remote villages in Meghalaya. Physical distance and lack of infrastructure play a major role in preventing access to care. Meghalaya is an extremely hilly state and during the monsoon season, road conditions are very poor. Ultimately these factors combined with cultural practices and attitudes contribute to the lack of utilization of health services.
After the meeting adjourned, we were given a tour of the PHC. It was well-maintained and had adequate healthcare personnel. Our hosts for the field visit provided us with lunch, where we were treated to traditional Khasi food. I was really touched by the kindness and hospitality of the people I encountered during the field visit. During the meeting, we were being served tea and snacks. I was feeling a bit queasy from the drive, so I settled on only drinking some tea. The woman sitting next to me who was from Jongksha Village, smiled at me and offered me some of her food. I was moved by the gesture and her beautiful smile :)
Following our field visit to Jongksha Village, we visited another remote village. This village was doing a great job of using allocated government funds for the development of Anganwadi centers and implementing other state programs. There, we attended another village council meeting where members of the village expressed both their concerns and gratitude to Mr. Kumar (Development Commissioner). Many young children joined the meeting and they were extremely adorable! We asked them "What do you want to be when you grow up?" and we were met with a variety of answers ranging from football player to driver. Their pureness and excitement for life were beautiful. At the conclusion of our visit, we were given red tea and gifted paan (betel nut) which is a common delicacy in the region. I ended the day feeling inspired and recommitted to the field of global health.
For me, these issues are global health, but for those living with these health issues daily, these issues are a matter of survival. I want to end with a quote that I remember reading in one of my public health ethics classes.
"Global health is academic, political, and economic in HICs. It is social, emotional, survival-related, and personal in LMICs."
The quote comes from Naidu's paper: "Says who? Northern ventriloquism or epistemic disobedience in global health scholarship."
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